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Does he have nausea? Then he wont want to eat. There are many very good medicines with little to no side effects that work well. Waiting until nausea is bad is waiting too long, and sometimes you never catch up. My Mom used to take a nausea medicine (Zofran) every morning to prevent nausea from even starting, when that was a problem.
Could have have gastroparesis? This is 'slow stomach emptying', a common complication of PC and common with Stage 4 disease. Slow stomach emptying means that you get a back up of food and digestive juices in the stomach that can prevent you from getting hungry. It can make you feel full after not eating very much. Also, it can cause symptoms like indigestion/reflux/burping/bloating and more. You don't have to have all of the symptoms. The doctors forget about this. Reglan is a very good medicine to try that can help this, and you need to take it correctly (15-30 minutes before meals and before bed), and there are others to try. Also, small meals spread throughout the day, avoiding trigger foods that make it worse (these vary, but common ones are high fat and high fiber foods) can help.
Is he depressed? PC actually causes depression and should be just as aggressively treated as pain. The cancer secretes a molecule that travels to the brain and causes this change in mood. Please ask the doctors about treating this. Depression can interfere with appetite, sleep, energy level and just is awful to deal with.
A little bit of 'exercise' helps appetite, and sleep. Exercise for us just sometimes means getting out of bed, moving around the house, going for a short walk, or even doing some errands or activities you enjoy. It helps, if you can.
Cancer itself can sometimes decrease appetite. There are appetite stimulants that can be tried, after the above things are treated. These include medical marijana/cannabis, marinol, megace, mirtazpine and more.
And sometimes it is important to let your loved one do what they want to do, and eat what they want to eat. Make sure you offer to get anything that they desire. You should not make restrictions on diet at this point. Even if they have diabetes, you can always adjust insulin to enjoy a donut, if that is what they crave. What is important now is to stimulate appetite, and mood, any way you can. Sometimes it is the most simple pleasures that keep us going.
If the oncologist is not helpful, ask to see the nutritionist in the cancer center or a gastroenterologist interested in PC for advice. It is important to be taking pancreatic enzymes also to make sure that the food you are eating is digested properly. The gastroenterologist can help with that as well. Finally, if you are fortunate enough to have a Palliative Care doctor that works with your cancer team, they can be very good at treating problems with appetite, pain, sleep, mood, energy and more. Ask if there is a Palliative Care doctor your loved one can see while they are still going through treatment to give you more help and advice.
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